Youth perspectives on sugar-sweetened beverages and the UK soft drinks industry levy: secondary analysis of focus group data using the theory of planned behaviour

Abstract Background Adolescents are among the highest consumers of sweetened beverages in the UK. The UK Soft Drinks Industry Levy (SDIL) was one of the first sugar sweetened beverage (SSB) taxes globally that aimed to incentivise manufacturers to reformulate SSBs to reduce their sugar content as an element of government plans to reduce childhood obesity. We aimed to develop a theoretically informed understanding of adolescents’ views of sugar, SSBs and the UK SDIL to explore how effectively the SDIL may be working in the target group and to inform future research in the long-term evaluation of the SDIL. The Theory of Planned Behaviour (TPB) has been widely used to assess dietary patterns quantitatively, however there is a lack of qualitative application, particularly in the context of population-based interventions such as the SDIL. Methods We conducted secondary analysis of focus groups with 23 participants from two state-funded schools in Essex, UK. Ages ranged from 11 to 14 years old, 15 were female, 8 were male. Transcripts were analysed using reflexive thematic analysis and we applied the constructs of the TPB qualitatively. Results Six interrelated and overlapping themes identified constructs of the TPB (attitudes, subjective norms, perceived behavioural control, intention and behaviour) and a lack of awareness of the UK SDIL among the adolescents. The most prominent subthemes that influenced adolescents’ perspectives were the attitude that ‘sugar is bad’ and parental restriction. An adaptation of the TPB model is proposed which illustrates the overlapping of constructs and incorporates a two-way feedback loop between perceived behavioural control and behaviour, which bypasses intention. Conclusion To our knowledge, this is the first study that applies the TPB qualitatively to analyse adolescents’ perceptions of sugar, SSBs, and the SDIL (a real implemented policy change). Adolescents expressed support for population-based interventions to reduce sugar consumption but were largely unaware of the SDIL. Therefore, it is suggested that expanding the SDIL to currently exempt SSBs and fruit juices could be acceptable to the target group and would likely further reduce sugar consumption. Further research is needed to explore perspectives regarding currently exempt drinks.